Insulin therapy in women with pregestational type 2 diabetes and its relevance to maternal and neonatal complications

Abstract

The objective of this study is to assess the insulin requirement, its determinants, and its association with maternal complications and neonatal outcome in women with pregestational type 2 diabetes mellitus. One hundred two insulin treated pregnant women with pre-existing type 2 diabetes and those clinically diagnosed with type2 DM during pregnancy were selected. Insulin dose, distribution, relation with meal was assessed. Statistical analysis was done and insulin requirement was correlated with maternal factors and fetal outcome. Insulin dose at the 1st trimester was 32.65 ± 23.11 units/day, i.e., 0.52 U/kg/day of pre-pregnancy weight, which significantly increased to 47.62 ± 29.54 U/day at delivery i.e., 0.76 U/kg/day (p < 0.0001). Insulin dose was positively correlated to fasting and 2 h postprandial plasma glucose at diagnosis. Pre-dinner insulin requirement was significantly higher than pre-breakfast in the 3rd trimester (P value: 0.018). 19.6% neonates had a low birth weight, 5.8% had macrosomia, and 18.63% had neonatal hypoglycemia. Subjects on insulin analog showed a lower risk of low birth weight (17.4%) and macrosomia (Nil) versus those on conventional insulin with 21.6 and 8.1%, respectively. Insulin requirement in type 2 diabetes pregnancies progressively increases from the 1st trimester till delivery. Meal-related assessment needs attention in Indian population due to their varied dietary culture. Low birth weight is more frequent than macrosomia in our population. More studies are needed to ascertain the concept of a better neonatal outcome with insulin analog.